Supratentorial Cerebrospinal Fluid Research Articles

Automated volumetric evaluation of intracranial compartments and cerebrospinal fluid distribution on emergency trauma head CT scans to quantify mass effect.

Intracranial space is divided into three compartments by the falx cerebri and tentorium cerebelli. We assessed whether cerebrospinal fluid (CSF) distribution evaluated by a specifically developed deep-learning neural network (DLNN) could assist in quantifying mass effect. Head trauma CT scans from a high-volume emergency department between 2018 and 2020 were retrospectively analyzed. Manual segmentations of intracranial compartments and CSF served as the ground truth to develop a DLNN model to automate the segmentation process. Dice Similarity Coefficient (DSC) was used to evaluate the segmentation performance. Supratentorial CSF Ratio was calculated by dividing the volume of CSF on the side with reduced CSF reserve by the volume of CSF on the opposite side. Two hundred and seventy-four patients (mean age, 61 years ± 18.6) after traumatic brain injury (TBI) who had an emergency head CT scan were included. The average DSC for training and validation datasets were respectively: 0.782 and 0.765. Lower DSC were observed in the segmentation of CSF, respectively 0.589, 0.615, and 0.572 for the right supratentorial, left supratentorial, and infratentorial CSF regions in the training dataset, and slightly lower values in the validation dataset, respectively 0.567, 0.574, and 0.556. Twenty-two patients (8%) had midline shift exceeding 5 mm, and 24 (8.8%) presented with high/mixed density lesion exceeding >25 ml. Fifty-five patients (20.1%) exhibited mass effect requiring neurosurgical treatment. They had lower supratentorial CSF volume and lower Supratentorial CSF Ratio (both p < 0.001). A Supratentorial CSF Ratio below 60% had a sensitivity of 74.5% and specificity of 87.7% (AUC 0.88, 95%CI 0.82-0.94) in identifying patients that require neurosurgical treatment for mass effect. On the other hand, patients with CSF constituting 10-20% of the intracranial space, with 80-90% of CSF specifically in the supratentorial compartment, and whose Supratentorial CSF Ratio exceeded 80% had minimal risk. CSF distribution may be presented as quantifiable ratios that help to predict surgery in patients after TBI. Automated segmentation of intracranial compartments using the DLNN model demonstrates a potential of artificial intelligence in quantifying mass effect. Further validation of the described method is necessary to confirm its efficacy in triaging patients and identifying those who require neurosurgical treatment.

Excessive release of endogenous neuropeptide Y into cerebrospinal fluid after treatment of spontaneous subarachnoid haemorrhage and its possible impact on self-reported neuropsychological performance – results of a prospective clinical pilot study on good-grade patients

ABSTRACTObjectives: Neuropsychological dysfunction after treatment of spontaneous subarachnoid haemorrhage (sSAH) is common but underreported. The vasoconstrictor neuropeptide Y (NPY) is excessively released after sSAH and in psychiatric disorders. We prospectively analysed the treatment-specific differences in the secretion of endogenous cerebrospinal fluid (CSF) NPY during the acute stage after sSAH and its impact on cognitive processing.Methods: A total of 26 consecutive patients (f:m = 13:8; mean age 50.6 years) with good-grade sSAH were enrolled (drop out n = 5): n = 9 underwent endovascular aneurysm occlusion, n = 6 microsurgery, and n = 6 patients with perimesencephalic SAH received standardized intensive medical care. Ventricular CSF was drawn daily from day 1–10. CSF NPY levels were determined with competitive enzyme immunoassay. All patients underwent neuropsychological self-report assessment [36-Item Short Form Health Survey (SF-36) and ICD-10-Symptom-Rating questionnaire (ISR)] after the onset of sSAH (day 11–35; t1) and at the 6-month follow-up (t2).Results: At t1, increased mean levels of NPY in CSF significantly correlated with impaired performance in most ISR scores (ISR total p = .018, depression p = .035, anxiety p = .008, nutrition disorder p = .047, supplementary items p = .038) and in several psychological SF-36 items (vitality p = .019, general mental health p = .001, mental component summary p = .025).Discussion: To the best of our knowledge, this study is the first to correlate the levels of endogenous NPY in supratentorial CSF with cognitive outcome in good-grade sSAH patients. Excessive NPY release into CSF may have a short-term influence on the pathogenesis of neuropsychological deficits. The impact of cerebrovascular manipulation on NPY release has to be further elucidated.Abbreviations: ANOVA: analysis of variance; aSAH: aneurysmal subarachnoid haemorrhage; AUC: area under the curve; CBF: cerebral blood flow; CSF: cerebrospinal fluid; CT (scan): computed tomography (scan); CV: cerebral vasospasm; DIND: delayed ischemic neurological deficit; DSA: digital subtraction angiography; EIA: enzyme immunoassay; EV: endovascular aneurysm occlusion; EVD: external ventricular drainage; FU: 6-month follow-up; GCS: Glasgow Coma Scale; Ghp: general health perceptions; GOS: Glasgow Outcome Scale; h: hour/s; HH: Hunt and Hess; ICU: intensive care unit; ISR: ICD-10-Symptom-Rating questionnaire; MCS: mental component summary; Mhi: general mental health; min: minute/s; min-max: minimum – maximum; ml: millilitre; mRS: modified Ranking Scale; MS: microsurgical clipping, microsurgical aneurysm occlusion; ng: nanograms; no. [n]: number; NPY: Neuropeptide Y; p: p value; Pain: bodily pain; PCS: physical component summary; Pfi: physical functioning; pSAH: perimesencephalic subarachnoid haemorrhage; PTSD: posttraumatic stress disorder; QoL: quality of life; Rawhtran: health transition item; Rolem: role limitations because of emotional problems; Rolph: role limitations due to physical health problems; SAH: subarachnoid haemorrhage; SD: standard deviation; SF-36: 36-Item Short Form Health Survey; Social: social functioning; sSAH: spontaneous subarachnoid haemorrhage; TCD: trans-cranial Doppler ultrasound; (test) t1: test in the sub-acute phase after the onset of bleeding (between day 11 and 35 after subarachnoid haemorrhage); (test) t2: test in the short-term (chronic phase) after treatment at 6-month follow-up; test t1 - t2: intergroup development from t1 to t2; Vital: vitality; vs: versus.

Variation in supratentorial cerebrospinal fluid production rate in one day: measurement by nontriggered phase-contrast magnetic resonance imaging

Measuring the cerebrospinal fluid (CSF) production rate is important for understanding the physiology related to normal conditions and neurological disorders. Triggered phase-contrast magnetic resonance imaging (MRI) has been used to measure CSF production rate, but the use of nontriggered phase-contrast MRI has not been reported. The purposes of this study were to assess the feasibility of using nontriggered phase-contrast MRI to measure CSF flow and to determine whether CSF production exhibits circadian rhythm. The feasibility of phase-contrast MRI was assessed with a phantom simulated human cerebral aqueduct. CSF flow through the cerebral aqueduct was measured with nontriggered phase-contrast MRI four times during 1 day in 10 normal volunteers. In the phantom study, linear regression analysis gave the following measured values (ml/h): 0.80 × (value of steady flow) - 10.0 for triggered phase-contrast MRI and 1.27 × (value of steady flow) - 12.2 for nontriggered phase-contrast MRI. One-factor analysis of variance showed no significant effect of the time of the measurements (P = 0.47). The supratentorial CSF production rate was 510 ± 549 ml/day (mean ± SD). Nontriggered phase-contrast MRI provided good estimates of the flow rate in the phantom study. We observed no circadian rhythm in CSF production.

Brain magnetic resonance imaging of siblings from families with two or more children with learning or intellectual disabilities and need for full-time special education

Several factors are involved in determining a child's need for special education (SE). Thus, the value of brain magnetic resonance imaging (MRI) for subjects with learning and intellectual disabilities is uncertain. To evaluate the usefulness of MRI in the diagnostic process of siblings with learning and intellectual disabilities and need for full-time SE. Altogether, 119 siblings (mean age 11.9 years) from families in which two or more children attended/had previously attended full-time SE underwent prospective brain MRI. SE grouping included three levels, from specific learning disabilities (level 1) to global intellectual disabilities (level 3). Forty-three controls (level 0, mean age 12.0 years) attended mainstream education groups. Signal intensity and structural abnormalities were analyzed, and areas of the cerebrum, posterior fossa, corpus callosum, vermis and brain stem, and diameters of the corpus callosum were measured. In analyses, all area measurements were calculated in proportion to the total inner skull area. Abnormal finding in MRI was more common for siblings (n=62; 52%) in SE (58% for level 3; 49% for level 2; 35% for level 1) than for controls (n=13; 16%). The siblings showed enlarged supra- (P<0.001) and infratentorial (P=0.015) cerebrospinal fluid (CSF) spaces and mild corpus callosum abnormalities (P=0.003) compared to controls. Siblings in SE had smaller inner skull area than controls (P<0.001). Further, the relative area of the mesencephalon (P=0.027) and the diameter of the body of the corpus callosum (P=0.015) were significantly smaller than in controls. In binary logistic regression analysis, enlarged supratentorial CSF spaces increased the probability of SE (odds ratio 4.2; P=0.023). Subjects with learning and intellectual disabilities commonly have more MRI findings than controls. Enlarged supratentorial CSF spaces were a frequent finding in siblings in full-time SE.

A late complication of CSF shunting: acquired Chiari I malformation

Acquired Chiari I malformation developing after cerebrospinal fluid (CSF) shunting is an intriguing late complication of CSF shunt surgery and not only raises questions as to its pathogenesis but also poses many queries about the possible adverse effects on the subsequent child development as well as on the indications and possibilities of surgical correction. We report a series of 17 patients with the neuroradiological evidence of an "acquired" Chiari type I malformation. These patients, 3 to 24 years (mean 11.3 years), had been treated previously with an extrathecal CSF shunt. The follow-up varied from 2 to 12 years (mean, 6). Neuroradiological investigation demonstrated a small posterior cranial fossa, small ventricles, markedly reduced periencephalic subarachnoid spaces, and thickening of the skull vault and base. The degree of tonsillar herniation did not correlate with clinical manifestations. All patients with severe clinical manifestations or with progressive worsening of neuroradiological findings were considered for surgical treatment. Decompressive supratentorial craniotomy seemed to fit with the purpose of enlarging the intracranial volume without the risk of aggravating the hindbrain herniation. An immediate relief of clinical manifestations was observed in all patients. Not surgically treated patients did not show any clinical or radiological modification during all the follow-up. This study contributes to the understanding of the underlying pathogenetic mechanisms of acquired Chiari type 1 malformation in cases of long-lasting supratentorial CSF shunting and provides a base for planning the best management, whether conservative or surgical.

Supratentorial Cerebrospinal Fluid Production Rate in Healthy Adults: Quantification with Two-dimensional Cine Phase-Contrast MR Imaging with High Temporal and Spatial Resolution

A method for objectively determining supratentorial cerebrospinal fluid (CSF) production rate is described. The method employs cine phase-contrast magnetic resonance imaging with high temporal and spatial resolution at the level of the aqueduct of Sylvius. Automatic encircling of the aqueduct was accomplished by using a pulsatility-based segmentation approach. Results in 23 healthy adults (18 men, five women; age range, 21-39 years) yielded an average CSF production rate of 305 microL/min +/- 145 (standard deviation); this rate is in good agreement with literature-reported values obtained with invasive ventriculolumbar perfusion measurements. Average operator imprecision was 23.1% if automatic segmentation was not used. The proposed method is potentially an effective means for measuring supratentorial CSF production rate in humans.

The size of the intra- and extraventricular cerebrospinal fluid compartments in children with idiopathic benign widening of the frontal subarachnoid space.

The aim of this study was to quantify the intra- and extraventricular cerebrospinal fluid (CSF) spaces in children with benign enlargement of the frontal subarachnoid space (BE). The infra- and supratentorial CSF compartments were measured in 61 CT examinations of children with BE, 3-27 months old, and compared with those of 96 CT examinations considered normal. Measurements of the ventricular system, and the pontine and chiasmatic cisterns were related to cranial size. In all children with BE the lateral and third ventricles were dilated and the chiasmatic cistern was widened. The subarachnoid space was wider than the upper limits in the control group, in the frontal region (4 mm), and the anterior interhemispheric (4 mm) and Sylvian (3 mm) fissures. The infratentorial CSF compartments, the occipital subarachnoid space, the posterior part of the interhemispheric fissure and, in most cases, the cortical sulci were normal in size in children with BE. The majority were macrocephalic or had rapid head growth but there were also normocephalic children with normal head growth. The size of the posterior fossa was within the normal range in all children with BE. Idiopathic BE is not uncommon in children up to about 3 years old who are healthy or have minimal neurological disturbance and is characterised by a specific pattern of widening of the supratentorial CSF compartments.

Assessment of CSF dynamics and venous flow in the superior sagittal sinus by MRI in idiopathic intracranial hypertension: a preliminary study.

A velocity-sensitive magnetic resonance imaging (MRI) phase-mapping method was used for non-invasive study of cerebrospinal fluid (CSF) flow in the cerebral aqueduct, for indirect calculation of supratentorial CSF production, and for measurement of blood flow in the superior sagittal sinus (SSS). We examined 12 patients with idiopathic intracranial hypertension (IIH; pseudotumour cerebri), and 10 healthy volunteers. The peak caudal and rostral CSF flow in the aqueduct during the cardiac cycle did not differ significantly between the patients and the volunteers. A significant correlation was found between the CSF volume flow amplitude and the resistance to cerebrospinal fluid outflow in the patients (p < 0.05). The calculated mean supratentorial CSF production rate was 0.79 ml/min in the patients and 0.70 ml/min in the controls, but this difference was not statistically significant. However, the MRI measurements suggested CSF hypersecretion in three patients, whereas increased transependymal passage of CSF could have been the cause of negative calculated CSF production rates in two others. A tendency towards lower mean blood flow in the SSS (mean 345 ml/min) in the patients than in the controls (mean 457 ml/min) was found, and in two patients showed very low values. We showed that MRI phase-mapping may be used to study the relative importance of the pathophysiological factors thought to play a role in the development of IIH.

Cerebrospinal fluid flow and production in patients with normal pressure hydrocephalus studied by MRI

An interleaved velocity-sensitised fast low-angle shot pulse sequence was used to study cerebrospinal fluid (CSF) flow in the cerebral aqueduct, and supratentorial CSF production in 9 patients with normal pressure hydrocephalus (NPH) and 9 healthy volunteers. The peak aqueduct CSF flow, both caudal and rostral, was significantly increased in patients with NPH. No significant difference in the supratentorial CSF production rate was found between patients (mean 0.60 +/- 0.59 ml/min) and healthy volunteers (mean 0.68 +/- 0.31 ml/min). Our method may be useful for investigation and monitoring of patients with NPH before and after ventriculoperitoneal shunt operations.